Table 3.
Reported outcomes of prehabilitation for colorectal cancer surgery.
| Author; Year | Impact on Physical Status | Impact on Postoperative Outcomes | Other Effects |
|---|---|---|---|
| Berkel et al. [26]; 2022 | Improved VO2 at the VAT and VO2peak. Quadriceps strength also increased in the prehabilitation group. | Significantly lower complication rate vs. the usual care group. | N/A |
| Alejo et al. [29]; 2019 | Improved VO2peak; after the exercise program, a tendency for increased mean levels of moderate to vigorous PA was observed. | N/A | Adherence to the program was 89% (primary outcome). The scores for the depression and the “emotional function” QoL domain were reduced in the prehabilitation group. |
| Morielli et al. [30]; 2021 | Improved VO2peak while VO2peak decreased in the control group. | Prehabilitation increased rates of pCR/near pCR compared to the control group. | No significant differences were observed between groups for grade ¾ toxicities or treatment completion. |
| West et al. [16]; 2015 | Improved VO2 at the VAT and VO2peak. | N/A | N/A |
| Moug et al. [31]; 2019 | A reduction in step count was observed in both groups, with the prehabilitation group experiencing a lesser decline (non-significant). Prehabilitation increased 6 MWT scores (non-significant). | N/A | The prehabilitation group achieved high levels of satisfaction. |
| Moug et al. [32]; 2020 | A reduction in daily step count was observed in both groups, with a more considerable reduction recorded in the control group. More patients in the intervention group achieved step count improvements at week 12. Prehabilitation increased muscle mass as determined by TPI. | N/A | N/A |
| Singh et al. [33]; 2017 | Prehabilitation increased muscle strength, endurance and preserved lean body mass and ASM. | N/A | No significant changes in any QoL measure or fatigue determined by MFSI scores were reported. There were no significant changes in general well-being at any point in time (assessed using the SF-36 questionnaire) and no adverse effects or health problems related to the exercise program during the training period. |
| Singh et al. [34]; 2018 | Prehabilitation significantly improved muscle strength for the lower limb exercises. While leg press endurance improved, there was no significant change in chest press muscle endurance. Physical performance as measured by 6 m fast walk and 6 m backwards walk improved in the Prehabilitation group. There was no significant change in 400-meter walk time; however, there was a substantial reduction in heart rate immediately after the completion of the test. | N/A | There were significant changes in 3 measures of QoL (emotional function, financial difficulties, diarrhea), with patients also reporting having less constipation. The exercise program did not cause any adverse events. |
| Heldens et al. [35]; 2016 | Prehabilitation increased patient walking distance as determined by 6 MWT and functional exercise capacity (not significant) as well as both leg and arm muscle strength (significantly). | N/A | The feasibility and safety of the program were observed, with a very high attendance rate (95.7%). |
| Loughney et al. [36]; 2017 | Significant improvements in lying down time, sleep efficiency, and duration were reported in the prehabilitation group compared to the control group.In all participants, there was a significant reduction in daily step count, EE, and MET. The apparent improvement in daily step count and overall PAL in the prehabilitation group was not statistically significant compared to the control group. | N/A | N/A |
| Gillis et al. [37]; 2019 | Prehabilitation did not significantly alter body mass compared to rehabilitation. The prehabilitation group had substantially more relative and absolute LBM and less FBM than the control group. | N/A | N/A |
| Gillis et al. [38]; 2016 | The prehabilitation group experienced a clinically meaningful improvement in 6 MWT scores. Recovery rates were similar between groups. No significant differences in self-reported outcomes were observed between the groups. | No significant differences were observed between the groups in an overall 30-day complications rate and severity, emergency department visits and readmission, and median length of stay. | N/A |
| Furyk et al. [39]; 2021 | N/A | N/A | Poor feasibility of an RCT for preoperative prehabilitation in frail colorectal patients was reported. |
| Bousquet-Dion et al. [40]; 2018 | No significant changes in 6 MWD were found between the groups; however, there was a significant correlation between physical activity, energy expenditure, and 6 MWD in the prehabilitation group. | There were no significant differences in the length of stay, emergency department visits, and complications rate between the groups. | Program compliance was 98%. |
| Tweed et al. [41]; 2021 | Prehabilitation improved handgrip strength and exercise capacity. No difference was observed in VO2max and VO2 at VAT before and after prehabilitation. | N/A | No adverse effects were reported. Organizational feasibility was achieved. Overall acceptability of interventions was positive. |
| Klerk et al. [42]; 2021 | Prehabilitation improved 6 MWT and 1-RM. | Compared to the standard care group, rehabilitation reduced complication rate, shortened the median stay, and patients had fewer unplanned readmissions. There was no significant difference in mortality between the groups. | N/A |
| Arias et al. [27]; 2021 | Reduced the deterioration of body composition as compared to the control group 45 days after surgery. These differences, however, were attenuated at 90 days. | Prehabilitation reduced hospital stay duration and postoperative complications. | N/A |
| Karlsson et al. [43]; 2019 | Prehabilitation significantly increased inspiratory muscle strength. | No significant increase in complications was observed in the prehabilitation group. The intervention group showed a shorter median length of stay and better recovery, although not statistically significant. | The recruitment rate was low, at only 35%. Compliance was much higher, at 97%. The overall intervention achieved a high level of acceptability. |
| West et al. [44]; 2019 | Prehabilitation reversed the fall in VO2 at VAT due to NACRT. | The prehabilitation group had significantly greater ypTRG at the time of surgery, which did not result in a significant difference in the ypT-stage. | N/A |
| Li et al. [17]; 2013 | Postoperative walking capacity improved significantly in the prehabilitation group at weeks 4 and 8. A higher share of patients recovered in the prehabilitation group compared to the standard of care at week 8. In addition, higher levels of physical activity before and after surgery were reported in the intervention group. | Similar postoperative complication rates and length of stay were observed in both groups. | Prehabilitated patients immediately before surgery had significantly decreased anxiety and depression symptoms. No clinically or statistically significant increases in any domains of HRQOL were reported for the prehabilitation group. |
VAT—ventilatory anaerobic threshold; N/A—not applicable; PA—physical activity; pCR—pathologic complete response; 6 MWT—6-minute walking test; TPI—total psoas index; MFSI—Multidimensional Fatigue Symptom Inventory; SF-36—36-Item Short Form Health Survey; CCI—comprehensive complication index; EE—energy expenditure; MET—metabolic equivalent; PAL—physical activity level; LBM—lean body mass; FBM—fat body mass; 1-RM—1 repetition maximum; 6MWD—6-minute walking distance; RCT—randomized controlled trial; ypTRG—postoperative pathological tumor regression stage; ypT-stage—postoperative tumor stage pathology; HRQOL—health-related quality of life.